Conquering the obstacles during the intervention of a proximal chronic total occlusion of right coronary artery with a concurrent significant ostial stenosis: a case report

Abstract

Percutaneous coronary intervention (PCI) on a proximal
chronic total occlusion (CTO) of the right coronary artery
(RCA) with concurrent ostial stenosis can be challenging
because of the significant difficulty in properly engaging
the catheter and providing stable support during the
procedure. We report the case of a 57-year-old man with
chronic coronary syndrome who underwent an elective
PCI at the Dr. Soetomo General Hospital in Surabaya, on
April 13th, 2022. At the beginning of the procedure, there
was difficulty in intubating the RCA, which required the
guide catheter replacement. The angiography revealed a
significant lesion at the ostium, a CTO at proximal to mid-
RCA with bridging collaterals, and a significant distal
lesion. Several strategies to improve guiding catheter
support during PCI are using large and supportive shape
guide catheters, deep guide catheter intubation, extra
support wire, microcatheter and guide catheter
extension.
The risk of pressure dampening and ischaemia upon
engagement should always be kept under consideration.
Keywords: Percutaneous, Coronary Intervention,
Catheters, Vascular Diseases, Ischemia, Angiography,
Intubation, Intratracheal